South Africa: Medical advances now enable weight loss for people with Type 2 diabetes
Tuesday, 28 February 2012: Scientific advances have yielded a new medicine which restores the normal functioning of key hormones that are disrupted in people suffering from Type 2 diabetes, offering hope to many sufferers of the condition.
It’s one of the big paradoxes of modern medicine:
… Weight gain is a risk factor for Type 2 diabetes1;
… And it’s been proven that overweight Type 2 diabetes patients, whether simply plump or severely obese, will benefit from even modest weight loss2,3
BUT
… Until now, many of the available treatments for Type 2 diabetes have either made patients gain weight, or remain weight neutral4. Losing weight has been one of the most difficult treatment goals for people with Type 2 diabetes to achieve5.
There is a new treatment from Novo Nordisk that mimics the naturally occurring hormone GLP-1 (glucagon-like peptide 1, a hormone produced in the gastrointestinal tract). GLP-1 enhances the function of the beta cells in the pancreas, (which are cells involved in insulin production). It also affects alpha cells which produce glucagon – another hormone which, in a healthy person, works to balance blood sugar by raising levels. GLP-1 makes the body more sensitive to the effects of insulin and increases the brain’s sense of satiety – that little voice in your head which tells you you’ve had enough and you’re not hungry any more6.
Dr Adri Kok, a specialist physician in private practice in Johannesburg with a particular interest in treating diabetes, participated in clinical trials for this new Type 2 diabetes medicine, manufactured by pharmaceutical company Novo Nordisk.
“The new treatment puts a highly effective weapon against disease progression in the hands of the practitioner. The weight loss benefits of the medicine are significant – one of my patients shed in excess of 30 kg in six months.”
Hormones in harmony
Type 2 diabetes occurs when the pancreas either fails to produce enough of the hormone insulin to help clear glucose (sugar) from the blood, or the body becomes resistant to insulin.
These abnormal levels cause a disharmony in the body’s vast symphonic orchestra of hormones: think of it as too much of the brass and too little of the violins. The new treatment is like a hormonal conductor coming in to lead the orchestra back into balance, bringing up the violins and toning down the brass. All of which adds up to good news for patients with Type 2 diabetes, because it means that this new medicine can root out two other paradoxical problems:
1. The aim of treatment is to return blood sugar to healthy levels. Unfortunately, many existing treatments for diabetes (combined with the patient’s individual metabolism) work at the same ‘pace’, as it were, continuously, and cannot distinguish between high and normal levels of blood glucose. The result? Potentially damaging episodes of hypoglycaemia (low blood sugar). Since low blood sugar is a risk factor for heart disease, and could also, in the long term, harm the brain and central nervous system, this is a real concern7. In addition, episodes of low blood sugar demand that the patient eat to bring the sugar level back up to a healthy range, which, of course, could cause weight gain. Patients with poor glucose control are often advised to change their eating pattern to one of multiple meals a day to cope with the hypoglycaemia. This is a massive shift, and often not feasible based on their existing lifestyles.
GLP-1 treatment triggers little or no hypoglycaemia, due to its effect being glucose dependent (it responds to the glucose level in the blood) – the higher the blood sugar, the greater its effect. Patients who have been on the new GLP-1 medicine together with metformin during clinical trials reported on the ease at which they were able to maintain good glucose control8,9.
2. Many Type 2 diabetes patients have difficulties in managing their weight5. In fact being overweight is a key risk factor for development of Type 2 diabetes in the first place1. Often these patients are given advice to lose weight through diet and exercise and at the same time given treatment that may cause them to gain weight. The new medicine deals with this through the effect, mentioned earlier, of earlier onset of satiety, resulting in lower food consumption while still feeling satisfied.
Future prospects
“Ideally, patients should go onto this drug as early as possible”, says Professor Juris Meier, consultant physician and head of diabetes research at the Department of Medicine, St. Josef-Hospital of the Ruhr-Universitat Bochum (RUB): “Meta-analyses of studies show that the medicine is effective across all stages of Type 2 diabetes. However, the greatest efficacy was found in patients at the early stages of the disease, thereby supporting the early use of the medicine.”
Patients who start using this medicine early may hope for another benefit: it’s possible – but not yet proven – that the active ingredient may slow the progress of diabetes. “There is evidence from animal studies that GLP-1 receptor agonists have the potential to slow the progression of diabetes,” says Professor Meier. Long-term studies currently underway will demonstrate whether this is true for humans too. In the meantime, the availability of a treatment option which holds out the hope of a stable and healthy blood sugar level and little or no hypoglycaemia combined with the probability of weight loss, will have many Type 2 diabetes patients singing.
References
1. www.bbc.co.uk/health/physical_health/conditions/obesity.shtml; sourced 4 February 2012.
2. Wing RR, et al. Long-term effects of modest weight loss in type II diabetic patients. Arch Intern Med 1987; 147: 1749-1753.
3. Goldstein DJ. Beneficial health effects of modest weight loss. Int J Obes Relat Metab Disord. 1992 Jun;16(6):397-415.
4. Hermansen K, Mortensen LS. Bodyweight changes associated with antihyperglycaemic agents in type 2 diabetes mellitus. Drug Saf. 2007; 30(12): 1127-1142.
5. http://care.diabetesjournals.org/content/28/6/1526.full, sourced 5 February 2012.
6. Baggio LL, Drucker KJ. Biology of Incretins: GLP-1 and GIP. Gastroenterology 2007; 132: 2131-2157.
7. Zoungas S, et al. Severe Hypoglycemia and Risks of Vascular Events and Death, N Engl J Med 2010; 363:1410-1418.
8. Nauck M, et al. Efficacy and Safety Comparison of Liraglutide, Glimepiride, and Placebo, All in Combination With Metformin, in Type 2 Diabetes, The LEAD (Liraglutide Effect and Action in Diabetes)-2 study; Diabetes Care, 2009;32(1): 84-90.
9. Garber A, et al; on behalf of the LEAD-3 (Mono) Study Group. Liraglutide, a once-daily human glucagon-like peptide 1 analogue, provides sustained improvements in glycaemic control and weight for 2 years as monotherapy compared with glimepiride in patients with type 2 diabetes. Diabetes, Obes Metab. 2011; 13: 348-356.
